Objective To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication. Methods 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication. Results Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%–100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632). Conclusions Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome. All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

中文翻译：

---

根据风险状况评估心脏手术对左侧感染性心内膜炎的预后影响

目的评价急诊心脏手术对左侧感染性心内膜炎（LSIE）预后的影响及其与患者基础风险及手术指征的关系。方法 2000 年至 2020 年间，在三个三级中心连续招募了 605 名 LSIE 和正式手术指征的患者：405 名在疾病活动期接受了手术，200 名尽管有适应症却没有接受手术。通过多变量分析和倾向评分分析评估紧急手术的预后影响。我们根据 ENDOVAL 评分定义的基线死亡风险和手术指征研究了手术的益处。结果 通过多变量分析（OR 0.260，95% CI 0. 162 至 0.416）和倾向评分（死亡率 40% 对 66%，p<0.001）。其最大的预后益处见于风险最高的患者（预测死亡率 80%–100%：OR 0.08，95% CI 0.021 至 0.299）。对于不受控制的感染指征（OR 0.385，95% CI 0.194 至 0.765），甚至合并心力衰竭（OR 0.220，95% CI 0.077 至 0.632），手术的益处尤其显着。结论 活动性 LSIE 期间的手术似乎显着降低了院内死亡率。风险越高，结果的改善就越大。与研究相关的所有数据都包含在文章中或作为补充信息上传。不适用。对于不受控制的感染指征（OR 0.385，95% CI 0.194 至 0.765），甚至合并心力衰竭（OR 0.220，95% CI 0.077 至 0.632），手术的益处尤其显着。结论 活动性 LSIE 期间的手术似乎显着降低了院内死亡率。风险越高，结果的改善就越大。与研究相关的所有数据都包含在文章中或作为补充信息上传。不适用。对于不受控制的感染指征（OR 0.385，95% CI 0.194 至 0.765），甚至合并心力衰竭（OR 0.220，95% CI 0.077 至 0.632），手术的益处尤其显着。结论 活动性 LSIE 期间的手术似乎显着降低了院内死亡率。风险越高，结果的改善就越大。与研究相关的所有数据都包含在文章中或作为补充信息上传。不适用。与研究相关的所有数据都包含在文章中或作为补充信息上传。不适用。与研究相关的所有数据都包含在文章中或作为补充信息上传。不适用。